Form Reg-1e - Application For St-5 Exempt Organization Certificate For Nonprofit Exemption From Sales Tax

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REG-1E (9-09)
NEW JERSEY DIVISION OF TAXATION
OFFICIAL USE ONLY
APPLICATION FOR ST-5 EXEMPT ORGANIZATION CERTIFICATE
DLN
- FOR NONPROFIT EXEMPTION FROM SALES TAX -
MAIL TO:
Determination _________________
NJ Division of Taxation
Read Instructions Before Completing This Form
Effective
Regulatory Services Branch
Date
___________________
PO Box 269
Trenton, NJ 08695-0269
INSTRUCTIONS
This form is only for 501(c)(3) organizations (exclusively religious, charitable, educational or scientific) or veterans’, emergency or PTA/PTO
organizations. Other types of organizations - such as seniors, social, fraternal or recreational clubs, unions or civic or tenants’ association - do
not qualify for sales tax exemption and should not complete this form. Enclose a copy of your IRS 501(c)(3) determination (not required from
veterans’, emergency or PTA/PTO organizations, which should enclose any IRS letter they have.) For further information (including for religious
organizations), see “Questions & Answers” on next page.
DO NOT USE THIS FORM TO INCORPORATE; for corporate information call 609-292-9292, or go to:
SIGN; mail this (with documents listed at bottom) to address above, left. Allow 4 weeks for processing. If you have questions, see next page.
-
A. Organization Name
B. FEIN #
_____________________________________________
(Federal Identification Number, if any)
______________________________________________________________
E. Provide name and address that ensures delivery of ST-5 to
C. Registered Corporate Alternate Name (if any)
______________________
you:.
Name: C/O ________________________________________________
______________________________________________________________
D. Physical Location: (An officer’s address may be used)
Entity Name: _______________________________________________
Street_________________________________________________________
Street _____________________________________________________
City______________________ State _______ Zip Code ________________
City ______________________ State ______ Zip Code ____________
F. County / Municipality/ (or Out-of-State ) Code
(codes on pages 3 & 4); other states’ codes at end of list
. 1. Will you collect New Jersey Sales Tax?
Yes
No
If yes, give date of first sale ________ / ________ / ________
G
(Collection not required if you have exempt organization certificate and only occasional sales)
Month
Day
Year
2. If you will collect sales tax, is your business located in?
Atlantic City
Salem County
North Wildwood
Wildwood Crest
Wildwood
H. Will you soon begin paying wages or salaries to employees working in NJ or to NJ residents?
(If you already withhold NJ income tax, answer “No”.)
Yes
No
If yes, give date of first wage or salary payment _______/_______/_______ and give date that gross payroll will exceed $1,000 _______/_______/_______
Month
Day
Year
Month
Day
Year
I. IF A CORPORATION, give State of Incorporation _________________ and date ______/______/______
J. Contact Person _____________________________________ Daytime Phone: (____) __________ Evening Phone: (____) __________
K. Provide the following information for up to 3 responsible officers.
NAME (Last Name, First, MI)
TITLE
HOME ADDRESS (Street, City, State, Zip)
FOR YOUR APPLICATION TO BE PROCESSED, YOU MUST SUBMIT A COPY OF THE ORGANIZATION’S:
1) Articles of Organization (Articles or Certificate of Incorporation, Constitution, Charter or Trust Agreement) and Bylaws; and
2) IRS Determination Letter stating that the organization is exempt from federal income tax under §501(c)(3) (for exceptions, see instructions
above).
If IRS 501(c)(3) letter is a “group” exemption letter, also submit letter or listing from your central organization indicating that your subunit is
included under a group 501(c)(3) exemption.
I certify that all information given in this application is correct and also that any documents submitted are true copies.
______________________________________________________________________________________________________________
SIGNATURE
Title or position
Date

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